Solthis started operations in Niger in 2004 in order to extended care delivery to the entire country. Today, 29 treatment sites are supported to address four key health issues: HIV/AIDS, tuberculosis, malaria and mother and child health.
Niger has one of the highest fertility rates in the world, at more than seven children for each woman. While the health situation in terms of infant and infant-juvenile mortality has improved, there are still major challenges in sexual and reproductive health as well as maternal and neonatal mortality.
The WHO reports 850,000 cases each year since 2010. Malaria is the leading cause of death among the most fragile groups: pregnant women and children under five.
The number of cases detected in the past three years has risen by 3.7% annually while the rate of successful treatment is declining, due in particular to increasing no-shows.
In 2014, 41,000 people were living with HIV/AIDS, including 9,000 children. Of these 9,000 children, only 7% have access to antiretroviral treatments.
Our operating context
Partners: ULSS (AIDS sector battle unit, Ministry of Health), CISLS (inter-sector coordination of the battle against STD/HIV/AIDS)
29 sites supported
12 health professionals mobilized in the field, including 8 nationals
8 areas of operation: Niamey, Tillabéry, Zinder, Dosso, Maradi, Diffa, Tahoua, Agadez
Focus of operations: HIV/AIDS, tuberculosis, mother-child health, hepatitis
Solthis has been present in Niger since 2004.
Approached by INAARV—Initiative for Access to Antiretrovirals—to help it develop HIV/AIDS treatment throughout the country, Solthis provides support for decentralization. The goal is to provide all populations, especially those living in outlying areas generally overlooked by the care circuit, with access to quality care.
2009-2010: Successful decentralization of access to treatment through regional hospitals
2010-2013: Extension of decentralization to district hospitals. Autonomy established for those involved in medical treatment.
2013: Guidance in decentralization throughout the country and introduction of tools for gathering and analyzing patient data, through the CASSIS project (capacity for access to care and the health information system).
“Managing Risk in Fragile States: Putting Health First!
Optimising the Efficiency of the Global Fund's Grants”
This evidence-based report is the result of a work over several months, including 4 missions (Guinea, Mali, Niger and Sierra Leone) and interviews with 140 stakeholders. Through this work, we identified bottlenecks in the implementation of the Global Fund's grants in the field, showing that the Global Fund's Risk Management Policy is not well-adapted to fragile states. The additional safeguard measures which have been put in place by the Secretariat after the investigations of the Office of the Inspector General were meant to mitigate the financial risks and to reassure donors. However, experiences in challenging operating environments clearly show that these measures are mainly focused on financial risks and have caused significant malfunctions that jeopardise both the impact and the sustainability of the programmes. In order to make progress and to cope with the challenges specific to fragile states, we think it is now time for the Board members and the donors of the Global Fund to opt for an ambitious and innovative policy, which would put financial risk at its proper place: behind risks to public health. The main recommendations we are addressing in the report aim to place the public health risk at the centre of the mechanism, by:
Improving the balance between the analysis and the management of the different risks.
Simplifying and clarifying the control procedures: limit the number of contractors and the levels of validation.
Defining indicators or objectives for terminating additional safeguard measures to encourage appropriation and capacity building.
Investigating the possibility of an increased presence of the Global Fund in the field, by missions of several weeks or several months.
Adapting the indicators and procedures of performance-based funding and accountability measures to fragile states.
Author(s) : A. Madec, D. Germanaud, V. Moya-Alvarez, W. Alkassoum, A. Issa, M. Amadou, S. Tchiombiano, C. Pizzocolo, F. Huber, S. Diallo, R. Abdoulaye-Mamadou Journal : PLOS ONE - Volume 6 - Issue 7 - e22787
Prof. C. Katlama, Prof. G. Brücker et S. Calmettes
On the occasion of its General Assembly, Solthis held Wednesday, July 6 at the Pitié-Salpêtrière, the 4th day meeting. Teams Solthis and partners in the field were present, especially from Mali, Guinea, Niger and Haiti. The presentations are available below on this page.
HIV testing: a challenge?
Y. Yazdanpanah, F. Huber, R. Tubiana, M. Idé
At the "Test and Treat", screening is an important theme in African contexts, as in Western countries. Also, the first workshop of the Scientific Day Solthis it was dedicated, moderated by Dr. M. Ide (Niger) and Dr. R. Tubiana (Paris). In his introduction, Dr. F. Huber (Solthis) presented the technical aspects of "rapid tests" raising the question of the limits of these tests, and the problem of lack of due process and the frequent inability to meet the temperature conditions recommended by the suppliers. This presentation was followed by a review of different screening strategies and the historical evolution of paradigms: the screening called "voluntary" to "provider-initiated testing for carers" as advocated by WHO and the various authorities health. Aspects of "cost effectiveness" of screening were then analyzed by Prof. Y. Yazdanpanah (Tourcoing). Dr. F. Lamontagne (Solthis Guinea) and Prof. M. Cisse (Guinea) have supported these statements by the West African experiences Solthis on screening in the care environment "opt out". If this type of screening "at the initiative of the caregiver" has made great advances in PMTCT or in tuberculosis centers, much remains to be done in other departments of medicine, where a high proportion of patients is not detected, not supported. Mobilization on this issue is more strategic than ever.
Despite the investment of Solthis on supply issues (ARV, all health products ...), stock-outs, especially for ARVs, are still common in the field and directly threaten the health of patients. The session dedicated to these issues was conducted by two doctors Dr. B. Diallo (Mali) and Dr. PM Girard (Paris). E. Guillard (Solthis Pharmacy Manager) said the overall functioning of the supply before presenting the main causes that lead to situations of stockouts. The threat of disruption of Guinea in February 2011 was taken as an example to highlight the failures at different levels of decision making. Teams in the field of pharmacy Solthis and their partners then described their daily actions, emphasizing the mode of intervention or Solthis tools developed together, such as coordinating groups and committees for monitoring supplies, tables edge compilation, analysis, alerting, quantification tools ... Finally, J. Langlois (Sidaction) and F. Foguito (TAW), representing civil society, concluded the session by the role of associations to fight against breakage, and more widely to improve the quality of care.
Prof. V. Calvez (Pitié-Salpêtrière, Paris) presented the situation of primary resistance throughout the world, before recalling the consequences attributable to virological choice of first-line treatments. He raised the problem of low genetic barrier of molecules commonly used in countries with limited resources (especially NNRTIs), especially when access to viral load is small or nonexistent.
This session, moderated by Prof. M. Cisse (Guinea) and Dr. G. Breton (Paris), addressed the issue of retention of patient care in the circuit, through various initiatives. After a general introduction of G. Lurton (Solthis), Dr. M. Ide (National Hospital of Niamey) lamented the difficulties of long-term monitoring of HIV patients in Niger, based on the experiences of ambulatory treatment center and day hospital in Niamey. The experience of Medecins du Monde, supporting marginalized populations in integrated centers in Asia, was reported by Dr. N. Luhman. Finally, Dr. Claude Pean, Haitian Institute Pereo Fame, introduced the operation of the center of Port-au-Prince, who has built an international program based on improving the encrypted performance.
HIV prevalence and renutrition in children hospitalised for severe malnutrition in Niamey (Niger) Autor(s) : R. Maiga-Mamadou, W. Alkassoum, M. Hamadou, A. Abdou, C. Pizzocolo, S. Diallo, C. Dezé, V. Moya-Alvarez, F. Huber, Y. Madec
HIV prevalence and renutrition in children hospitalised for severe malnutrition in Niamey (Niger)Autor(s) : R. Maiga-Mamadou, W. Alkassoum, M. Hamadou, A. Abdou, C. Pizzocolo, S. Diallo, C. Dezé, V. Moya-Alvarez, F. Huber, Y. Madec
Evolution de la prise en charge du VIH à Ségou entre 2003 et 2009 Author(s) : L. Diakité, D. Katilé, , N. Diallo, A. Doumbia, MS. Koné, B. Coulibaly, A. Sidibé, Y. Coulibaly, A. Akondé, G. Lurton, F. Huber Download the presentationEvaluation de la mise en place du dépistage et de la prise en charge du VIH au centre antituberculeux Carrière, à Conakry (Guinée) Author(s) : LM. Camara, B. Bah, D. Touré, P. Kourouma, L. Hajouji, C. Katlama, F. Huber, O. Sow Download the presentationDélégation de la prescription des antirétroviraux aux paramédicaux dans la PTME à Ségou (Mali) Author(s) :A. Doumbia, A. Sidibé, AT. Traoré, A. Akondé, F.Z.T. Sangaré, DC. Traoré, M. Maiga, AM. Soumaré, F.D. Cissé, SD. Naman, G. Lurton, C. Katlama, F. Huber Download the presentationCharge virale en routine dans un pays à ressources limitées : le cas du Niger Author(s) : Dr Hanki, H. Yahayé, S. Mamadou, I. Aboubacar, R. Ali Maazou, I. Dillé, C. Dézé, S. Diallo, F. Huber, M. Amadou, F. Maïga Download the presentationL'épidémiologie des perdus de vue dans les programmes VIH/SIDA Author(s) : E. Poulet, M. Pujades-Rodriguez Download the presentationL'approche anthropologique des ruptures de suivi médical des personnes vivant avec le VIH : l'exemple de Kayes (Mali) Author(s) : S. Carillon, V. Petit Download the presentationLes patients sous ARV perdus de vue : l'expérience de l'ONG WALE Author(s) : D. KatiléDownload the presentation
Corrélation entre les activités d'éducation thérapeutiques (ETP) et l'échappement virologique au Niger : Les activités d'ETP sont-elles favorables au succès virologique ? Autor(s) : H.Baoua, M. Naba Fati, I.Amy, F.Maïga, M.Saidou, G.Lurton, S.Diallo, E.Guillard, F.Huber., L.Pizarro Download the posterCréation d'un outil permettant de visualiser simplement la couverture des besoins en ARV dans un contexte d'extension de la prise en charge Autor(s) : E. Guillard, X. Paris, S. Ouvrard, M. Diallo, L. Pizarro Download the posterPremière évaluation nationale de la réponse virologique aux antirétroviraux à Madagascar Autor(s) : S. Andriantsimietry, F. Lamontagne, M. Randria, J. Nely, S. Randriamampionona, VJ. Soanomena, WR Lehimena, JN Andriambelo, F. Huber, L.R. Razanakolana Download the poster"Effet-centre" et fidélisation du patient infecté par le VIH dans le circuit de soin. Expérience de 2 pays Ouest-africains Autor(s) : F. Huber, A. Akondé, G. Lurton, I. Kamaye, AB. Dicko, S. Diallo, S. Tchiombiano, N. Daries, P. Teisseire, L. Pizarro Download the poster
The Scientific Days, organized by the ULSS and CMT, in partnership with Solthis and GIP Esther, took place on 2 and 3 October 2009 in Niamey in the presence of Professor Katlama (Solthis President), Prof. Brucker (Treasurer Solthis and CEO of Esther) but also of Dr Kassi (Ivory Coast) and Professor Toure (Senegal). More than 250 physicians, health professionals, representatives of the fight against HIV, tuberculosis in Niger attended these days. Many topics on Chess therapeutic Opportunistic Infections, PMTCT, Accidents of exposure to blood and the delegation of tasks were discussed.
HIV/AIDS care and follow-up on a national scale in low resource settings: experience of the Niger Initiative on Antiretroviral Access (INAARV), NigerAuthor(s) : M. Ide, Y. Madec, M. Boubacar, E. Adehossi, C. Dezé, GM. Lawal, O. Amadou, S. Diallo, C. Pizzocolo, IA. Touré, S. Mamadou, C. Katlama and the National Technical Committee Download the presentationPilot cell comprehensive care: a multidisciplinary service orientation and listening PHAs, NigerAuthor(s) : A. Alzouma, C. Dezé, B. Sabo, M. Bako, S. Maman, I. Mourtala, M. Goundara, F. Djermakoye, M. Ide, F. Aeberhard Download the presentationThe impact of prior recourse to traditional medicine on the out-of-pocket expenditure of HIV/AIDS patients in NigerAuthor(s): S. Walker, S. Tchiombiano, A. Maiga, R. Hassane, M. Idé, AH. Souna, V. Bignon, O. Weil, L. Pizarro Download the presentationIncidence and risk factor for tuberculosis (TB) in HIV patients on ART, Niger Author(s): A. Foucher, Y. Madec, S. Diallo, Z. Thiousso, I. Dillé, S. Gambo, HA. Souna, A. Oumarou, A. Manou, GM. Laoual, Al. Touré, C. Pizzocolo, L. Pizarro, A. Fontanet Download the presentationDecentralized access to triple therapy and viral load monitoring in West Africa (Mali)Author(s) : A. Akondé, Y. Madec, AB. Dicko, I. Haidarra, I. Katile, B. Diarra, M. Kye, A. Doumbia, C. Pizzocolo, C. Katlama and the Segou Medical Technical Committee Download the presentationA method of HAART decentralization in rural areas: Solthis' experience in Segou (Mali)Author(s) : P. Teisseire, A. Akondé, C. Pizzocolo, S. Calmettes, S. Dalglish, N. Bodo, L. Pizarro Download the presentationPrevention of mother-to-child transmission of HIV (PMTCT) in a rural setting : the experience of the Segou region in MaliAuthor(s) : CD. Traoré, A.akondé, T. Samake, T. Traoré, Y. Coulibaly, O. Coulibaly, A. Sidibé, D. Germanaud, Z. Traoré, A. Maiga, AG. Marcelin, C. Pizzocolo, C. Katlama and the Segou Medical Technical Committee Download the presentationAppraisal of treatment modification in HIV patient follow-up in the region of Segou (Mali)Author(s) : J. Landier, A. Akondé, C. Pizzocolo, I. Haidara, M. Drabo, L. Pizarro, A. Fontanet, C. Katlama, Y. Madec Download the presentationEtude virologique chez des sujets VIH-1 suivis à MadagascarAuthor(s) : F. Lamontagne, S. Andriantsimietry, ML. Chaix, JP. Viard, M. Randria, J. Nely, S. Randriamampionona, C. Aguilar, S. Royer, C. Pizzocolo, LR. Razanakolona, C. Rouzioux Download the presentation
International AIDS Conference – Mexico City, August 2008
HIV-infected children in the context of the Niger Initiative on Antiretroviral Access (INAARV), Niger (West Africa)Author(s) : R. Abdoulaye-Mamadou, I. Adehossi, Y. Madec, C. Dezé, W. Alkassoum, M. Mahamane, I. Daouda, M. Amadou, D. Germanaud, C. Pizzocolo, S. Mamadou, C. Katlama and the National Technical Pediatric Committee Download the presentationLooking for lost to follow-up patients: experiences of Segou (Mali)Author(s) : G. Lurton, A. Akondé, Y. Madec, P. Teisseire, T. Traore, B. Touré, D. Cissé, C. Koumaré, C. Pizzocolo, L. Pizarro, C. Katlama, and the Segou Medical Technical Committee Download the presentation
Les personnels de santé face au Sida et à la prise en charge des PVVIH à Niamey. Transformation ou reproduction des représentations et pratiques habituelles ?